Medicaid Rate Setting and Audit

MRO14's are also known as Paid Claims Reports (PS&R's).

All requests for Nursing Home MRO-14's should be addressed to Mary J. Mason of the DHH Rate & Audit Review Section at [email protected], phone (225) 342-4130, fax (225) 342-1834 or (225) 342-1411.

For Hospital MRO-14:  Please contact Andrea Taylor (225) 342-3927

For ICF/MR MRO-14:  Please contact Enrika Buggage (225) 342-1999

ADHC’s:
a.       Any new facility that has been in operation for at least a year.

b.      The facilities that have been operating the longest without an audit.

“The following should be submitted for each facility: Two (2) paper copies and three (3) electronic copies on either diskette or CD are required in each case for the Medicare cost report (CMS Form 2540-96) including the Compliance Questionnaire (CMS Form 339), the Louisiana Medicaid Supplemental Cost Report, and the Medicare home office cost report (CMS Form 287-92) if applicable.”  Rate and Audit Review also needs paper copies of all the attachments submitted with the cost report packet.

Yes, you must file the Medicare cost report for Medicaid purposes.  Louisiana’s Medicaid program has adopted the Medicare skilled nursing cost report, CMS Form 2540-96 and the Medicare Home Office Cost Statement, CMS Form 287-92 for Medicaid cost reporting purposes. See LAC 50:VII.1303.  Nursing facilities participating in the Louisiana Medicaid program must complete the skilled nursing facility cost report adopted by the Medicare program (CMS Form 2540-96) in order to satisfy cost reporting requirements. For nursing facilities under the ownership of a hospital, the cost reporting document is the Health Care Financing Administration (HCFA) 2552.

The home office is not required to have the same year-end as the facility.  The home office should file its cost report based on the home office’s year-end.  When the home office accounting period differs from the cost reporting period of the related facilities, the allowable home office costs of the provider for the period covered by the home office cost statement should be included in the provider’s cost report.  An amount of allowable home office costs for the provider for the portion of its reporting year not covered by the home office statement will be tentatively projected at a rate not in excess of the previous year’s home office costs as set forth in the applicable home office cost statement.

Example:  The home office has an accounting year ending August 31, 2002.  For that year, home office costs of $120,000 were allocated to Provider A and $84,000 to Provider B.  Provider A’s reporting year ends on December 31; Provider B’s reporting year ends on March 31.

Of the $120,000 costs allocated to Provider A, $40,000 applies to its reporting year ended 12/31/01, covering the period from 9/1/01 to 12/31/01; and $80,000 applies to its reporting year ending 12/31/02, covering the period from 1/1/02 to 8/31/02.  Therefore, in its cost report for the year ending 12/31/02, Provider A may include home office costs of $40,000 projected for the period 9/1/02 to 12/31/02, which is not covered by the home office cost statement ($10,000 per month x 4 months).

Of the $84,000 allocated to Provider B, $49,000 applies to its reporting year ending 3/31/02, covering the period from 9/1/01 to 3/31/02; and $35,000 applies to its reporting year ending 3/31/03, covering the period from 4/1/02 to 8/31/02.  Therefore, in its cost report for the year ending 3/31/03, Provider B may include home office costs of $49,000 projected for the period 9/1/02 to 3/31/03, which is not covered by the home office cost statement ($7,000 per month x 7 months).

Then, the following year, when actual costs are determined, the projected amounts will be adjusted to agree with the actual amounts, and appropriate adjustments made.

Source:  Provider Reimbursement Manual Part I, Section 2150.3

Facilities are required to file the Medicare cost report based on their fiscal year end. The cost reporting period begin date shall be the later of the first day of the facility’s fiscal period or the facility’s Medicaid certification date. The cost reporting end date shall be the last day of the facility’s fiscal period.

The facility must file the Medicare cost report for the entire year to meet Louisiana’s Medicaid cost reporting requirements. The cost reporting period begin date shall be the later of the first day of the facility’s fiscal period or the facility’s Medicaid certification date. The cost reporting end date shall be the last day of the facility’s fiscal period.

Yes, your fiscal year for Medicaid cost reporting purposes may be different from your fiscal year for Medicare cost reporting purposes. However in doing this you will be completing two separate cost reports using the CMS Form 2540-96.

No, you should complete the Medicare cost report as required by the Medicare Provider Reimbursement Manual. All Medicaid required adjustments should be made only on the LA Supplemental Cost Report schedules.

A subscription service manual is available for purchase on the Internet at http://bookstore.gpo.gov/regulatory/health.html. You can also call the U.S. Government Online Bookstore toll free at 1-866-512-1800. The stock number is 917-007-00000-4. This comprehensive sourcebook can keep you informed of the latest changes in Medicare policies and procedures and help you determine the reimbursement for Medicare services you provide. This manual is formerly known as HCFA Publication 15-1. The price is $327.00.  You can also download a copy of the manual at www.cms.gov/manuals/cmstoc.asp.  Also, CCH offers the Medicare and Medicaid Guide. The Guide is a comprehensive resource containing manuals, court decisions, cost report forms, detailed instructions, Medicaid information, and latest developments. This Guide can be located on the web at http://onlinestore.cch.com. You can telephone 1-800-449-9525 for more information.

Yes, salary limits apply to home office personnel also.

The cost report instructions for ICF/MR and Adult Day Health Care facilities are included in the LDH Residential Care Rate Setting Manual.  A copy of this manual can be obtained from Rate and Audit Review.  Also, instructions related to the cost report software are integrated into the Cost Report help files on the Medimax web site.

NURSING HOMES:
a.       The facility was a Skilled Nursing – Infectious Disease (SN-ID) and/or a Skilled Nursing – Technology Dependent Care (SN/TDC) provider the previous year.

b.      The facility did not submit a cost report for the previous year.

c.       The facility had a disclaimer on the previous year’s audit.

d.      The facility had problems with provider fees..

e.       The facility had not been audited in the previous two years.

According to the Louisiana MDS Rule, a Delinquent MDS resident assessment is defined as "an MDS assessment that is more than 121 days old, as measured by the R2b date field on the MDS."

Remember that this definition is applied to the Case Mix system and does not replace the federal obligation to complete a standard (comprehensive or quarterly) assessment every 92 days.